Evidence suggests that altered metabolism can have an important role in the development of HIV‑associated wasting
What is HIV‑associated wasting?
Who may be at risk?
HIV‑associated wasting is a serious, underdiagnosed condition that may impact a range of patients living with HIV, including those who are well controlled on ART.7,8
HIV‑associated wasting may affect a range of patients 2,7-9
Many of your patients may be at risk for HIV‑associated wasting, including:
- Newly diagnosed patients
- HIV Long-Term Survivors
- HIV‑positive patients with normal CD4 counts and controlled viral loads
- Patients on ART who fail to gain weight
- Patients on ART with acute infection
- Patients with advanced HIV disease
- Poor virologic responders
- Patients who have been nonadherent to ART
More men experience HIV‑associated wasting, but it can occur in women, too.
Many factors contribute to HIV‑associated wasting2,5
The exact causes of HIV‑associated wasting remain unknown and are unique to every patient. HIV‑associated wasting is a diagnosis of exclusion. There are several factors associated with altered metabolism and/or reduced caloric intake that may result in unintentional weight loss in your patients living with HIV.
Opportunistic infections (OIs)7,11-13
- OIs related to HIV have been shown to increase the risk of unintentional weight loss and may lead to metabolic changes
- Persistent HIV infection leads to long-term immune activation and chronic inflammation, even in HIV‑positive patients on ART with undetectable viral loads
- In patients living with HIV, this chronic, systemic inflammatory response leads to the ongoing loss of LBM, which may lead to unintentional weight loss
- Dysregulation of metabolic pathways can result in inappropriate depletion of LBM, body weight, and a relative preservation of body fat
- In HIV‑positive patients, endocrine dysfunction is a common clinical manifestation
- There is a high correlation between loss of LBM and hypogonadism in HIV‑positive men who are on ART
- Among HIV‑positive women, decreased levels of free testosterone are also significantly associated with HIV‑associated wasting
Growth hormone (GH) resistance 2,9,17,19
- GH secretion and action are affected by nutritional status and changes in body composition
- In HIV‑associated wasting patients, a pattern of acquired GH resistance is seen, with increased GH and simultaneously decreased concentrations of insulin growth factor-1 (IGF-1)
- The GH/IGF-1 axis is one of the regulators of muscle protein metabolism that is altered in patients with HIV‑associated wasting